living your best to the end

Dr Paul Dorian: CPR insights from a man dedicated to our hearts

3 questions about Cardio Pulmonary Resuscitation (CPR)

Advanced Cardiac Life Support
Dr Paul Dorian
As always, before launching into questions, I  explain my sense about the topic, CPR, to. Dr Paul Dorian  “I think we ‘real people’ have neither the information nor the context to make informed decisions about CPR.” His answer: comprehensive, concise, hugely helpful.

The CPR decision is complex, fraught and depends on the individual, their underlying diseases, and the situation.

As a decision-maker here are the questions to ask:

  1. How likely is going to be that CPR is going to be life-saving in the short term – whether it’s 30 minutes or a day.
  2.  How likely is this person going to return to meaningful Quality of Life – with the definition of ‘meaningful’ is different for each of us
  3. What’s the intermediate or long-term outlook for this person’s overall health – say 6 months to 2 years. For example if this person has late stage kidney disease, their life expectancy may not be that long.

Another factor to consider when undertaking CPR is timing:

For instance, if a heart attack happens outside the hospital, the success rate for ‘Basic CPR’  – mouth to mouth or auto defibrillators (AED)– is 4-6%.  The reason for that low ‘success rate’ is because of the timeliness of the intervention. It often takes too long to do that CPR. In the hospital, the success rate goes up to 20-25% but that’s still pretty low.

When decisions of life and death have to be made, if you haven’t thought about and talked about your preferences and values there’s no time for philosophizing when there’s a health crisis. For most people, these are not easy things to talk about.

Another layer is that doctors often have neither the time nor the training to deal with these sensitive issues, and to deal with these issues sensitively: appreciating and understanding where the patient is coming from, then translating that into appropriate medical action.

These are situations that are emotionally laden, and complicated by the reality that when a patient or family member asks ‘how much time does he/she have to live’ we can’t know  – we can’t know the future.

Sometimes it’s a question of ‘what do you want to die of?’

I ask : “Might you have a suggestion/direction/advice for those at with a family history of heart disease/heart attack or are otherwise at risk of needing CPR?”

For most people the risk of needing CPR ( even if they had a heart attack ) is about 1% per year or less.

 If they have a cardiologist, they should ask explicitly:Doc, what is my chance of dying suddenly? The answer is usually expressed as a percentage probability in the next year, and  this is usually known.

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